Provider Demographics
NPI:1093569865
Name:HERTZOG, MARIA (L AC, DACHM)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:
Last Name:HERTZOG
Suffix:
Gender:F
Credentials:L AC, DACHM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2036 N GILBERT RD STE 2-208
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-2139
Mailing Address - Country:US
Mailing Address - Phone:480-420-4783
Mailing Address - Fax:
Practice Address - Street 1:2135 E SOUTHERN AVE
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7503
Practice Address - Country:US
Practice Address - Phone:480-420-4783
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-012203171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist